摘要
目的探讨”黄氏三步法”在进展期胃上部癌腹腔镜保脾脾门淋巴结（No．10淋巴结）清扫术中应用的临床疗效。方法回顾性分析2013年3—12月福建医科大学附属协和医院采用“黄氏三步法”行腹腔镜保脾No．10淋巴结清扫术的122例进展期胃上部癌患者的临床资料。全部患者行腹腔镜根治性全胃切除并保脾脾门淋巴结清扫术。分析患者术中、术后及并发症等情况。术后采用门诊、登门拜访、信件及电话等方式进行随访，随访时间截至2014年3月1日。结果1例患者因术中损伤脾动脉干而行脾切除术，其余121例均成功行腹腔镜保脾No．10淋巴结清扫术。患者总手术时间为（175±27）min，术中出血量为（60±43）mL；No．10淋巴结清扫时间为（21±8）min，出血量为（15±13）mL。122例患者淋巴结清扫总数为4797枚，每例患者淋巴结清扫数目为（44±18）枚。No．10淋巴结清扫总数为354枚，每例患者No．10淋巴结清扫数目为（2．9±2．4）枚。15例患者共37枚No．10淋巴结发生转移，转移率为12．30％（15／122）。患者术后肛门排气时间为（4．0±0．8）d，术后进流质饮食时间为（4．9±1．8）d，术后住院时间为（12±7）d。术后并发症发生率为11．48％（14／122）。122例患者全部获得随访。中位随访时间为8个月（2～12个月）。随访期间未发现肿瘤复发或转移，无一例患者死亡。结论“黄氏三步法”简化了进展期胃上部癌腹腔镜保脾No．10淋巴结清扫术复杂的手术步骤，临床疗效满意。
Objective To investigate the clinical efficacy of Huang＇s three-step maneuver in laparoscopic spleen-preserving splenic hilar （ No. 10 lymph node ） lymphadenectomy for advanced proximal gastric cancer. Methods The clinical data of 122 patients who underwent laparoscopic spleen-preserving No. 10 lymphadenectomy for advanced proximal gastric cancer by Huang＇s three-step maneuver at the Affiliated Union Hospital of Fujian Medical University from March 2013 to December 2013 were retrospectively analyzed. All the patients received laparoseopy-assisted radical total gastrectomy combined with spleen-preserving D2 lymph node dissection. The intra- operative and postoperative recoveries and complications of patients were analyzed. All patients were followed up by outpatient examination, visit, correspondence and telephone interview up to March 1,2014. Results One patient received splenectomy due to intraoperative splenic artery injury and the other 121 patients received successfully laparoscopic spleen-preserving No. 10 lymphadenectomy. The operation time, volume of intraoperative blood loss, time and volume of blood loss in No. 10 lymphadeneetomy were （175±27）minutes, （60±43）mL, （21±8） minutes and （15±13 ）mL, respectively. The total and mean numbers of lymph node dissection in 122 patients were 4 797 and 44 ± 18, respectively. The total and mean numbers of No. 10 lymph node dissection were 354 and 2.9 ± 2.4, respectively. Thirty-seven No. 10 lymph node metastases were detected in 15 patients, with a metastasis rate of 12.30% （15/122）. The time to anal exsufflation, time for fluid diet intake, duration of hospital stay and incidence of complications were （4.0 ±0.8） days, （4.9 ±1.8）days, （ 12±7） days and 11.48% （14/122） , respectively. All the 122 patients were followed up for a median time of 8 months （range, 2-12 months）. No tumor recurrence, tumor metastasis and death were observed during follow-up. Conclusions Huang＇s three-step maneuver simplifies the complicated surgical procedures of laparoscopie spleen-preserving No. 10 lymphadeneetomy for advanced proximal gastric cancer, its clinical efficacy is satisfactory with an advantage of clinical application.
出处
《中华消化外科杂志》
CAS
CSCD
北大核心
2015年第3期187-191,共5页
Chinese Journal of Digestive Surgery
基金
国家临床重点专科基金[（2012）649]
福建省科技计划重点项目（2014Y0025）
关键词
胃肿瘤
腹腔镜检查
脾门
淋巴结清扫术
Gastric neoplasms
Laparoscopy
Splenic hilar
Lymph node dissection
